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As resources to address substance use are disproportionally scarce in rural areas, a better understanding of this polysubstance use is critical to allocate and direct interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The Rural Opioid Initiative comprises 8 research cohorts spanning 10 states and 65 rural counties. Participants were recruited from January 2018 to March 2020 and eligibility included past 30-day opioid use by any route or past 30-day injection of any substance. Analyses were restricted to participants reporting past 30-day opioid use and either benzodiazepine or stimulant use. We described bivariate cross-sectional associations between benzodiazepine+opioid use, compared with stimulant+opioid use, and substance use behaviors, health outcomes, injection drug use, addiction treatment, and criminal legal system involvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of the 1107 ROI participants that met inclusion criteria, 10% (n = 107) reported benzodiazepine+opioid use, and 90% (n = 1000) reported stimulant+opioid use. The benzodiazepine+opioid group, compared with the stimulant+opioid group, had a higher use of opioid pain medication (73% vs 55%), gabapentin (43% vs 23%), and clonidine (12% vs 4%) to get high and used these substances more frequently; they also reported more frequent heavy episodic drinking (6.1 days per 30 days, SD = 9.4 vs 4.1 days, SD 7.5). The benzodiazepine+opioid group reported a lower prevalence in the past 6 months of law enforcement stop-and-search incidents (29% vs 48%), arrests (11% vs 28%), probation (22% vs 34%), jail\/prison (18% vs 41%), and fewer days in jail\/prison (4.7, SD = 19.1 days vs 15.9, SD = 35.7 days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>We found that benzodiazepines+opioids use was associated with more heavy episodic drinking and gabapentin use, and lower prevalence of criminal legal system involvement. These data suggest that individuals reporting benzodiazepines+opioids use have distinct behavioral patterns and outcomes that require targeted interventions for rural populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342251331701","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T03:14:12Z","timestamp":1745982852000},"page":"847-858","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Benzodiazepines and Opioid co-use Among Rural People Who Use Drugs: Findings From the Rural Opioid Initiative"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5149-8859","authenticated-orcid":false,"given":"L. 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